AMR One Health initiatives actions and lessons from the national action

plan in the animal sector in France

AMR One Health network

Cécile ADAM – expert in veterinary medicines –

cecile.adam1@agriculture.gouv.fr

Context

• Antimicrobials = common good to preserve;

• Reduce and improve antibiotic use;

• Develop alternative solutions ;

• Shared responsibility among private and public stakeholders

2

One Health

Context in France in 2010

• Weaknesses :

FR among high users in Europe

Lack of awareness and some bad practices

No NAP in the animal sector

• But also some strengths:

Good governance with clear regulatory framework

Existing monitoring of AMU and AMR

Some initiatives taken by professionals

Second NAP in the human sector to learn from

3

3. The French commitment: the Ecoantibio Action Plan 2012-2016

4

First step: co-construction of the

plan with all the stakeholders

Stakeholders were entrusted with

the implementation of some

measures

Five-year objective plan: 2012 - 2016 Key message: responsible and prudent use of antimicrobials

Quantitative objectives:

• Reduce by 25% animal exposure to antimicrobials in 5 years

• Reduce by 25% animal exposure to critically important antimicrobials in 3 years

Budget: 2 millions euros / year since 2013

Actions:

• Regulatory/ mandatory measures;

• Incentive measures;

• Research financing;

• Communication;

• Training;

• Monitoring of AMU and AMR 5

Examples of 2 regulatory measures

1) Restrict the use of critically important antibiotics

Objective : avoid the use of critically important antibiotics (CIA) (which should be used only to treat human diseases) whenever other medicine or antibiotics can be used successfully

Legal tools:

• Preventive use of CIA is forbidden

• Curative and metaphylactic use possible only after:

Clinical examination or necropsy

Sampling and identifying the bacteria

Sensitivity testing

2) Ban on discounts for antibiotics sales

6

Example of an incentive measure

Communication Campaign Targeting

7

Pet owners: « Antibiotics are not automatic

for us either »

Farmers: « Fed, Housed, Vaccinated »

• Promotes good husbandry practices

• Promotes alternatives to antimicrobials

Examples of communication

• In France:

Regional seminars Ecoantibio

Interministerial symposium Novembre, 14th

Review to promote prudent use

• In the EU

• At the international level

8

2017, Nantes vet school

2018, Clermont-Ferrand

One Health

Network of regional veterinary experts in antibiotherapy: pilot project

9

Examples of research projects

• Ecoantibio’s funding

• E-bug project

10

One Health

Project’s name Specie Budget

DALI : Study and monitoring of the

evolution and persistence of

antibiotics in the environment

Pig 195 600

AQUARES : pilot study of resistant

bacteria upstream and downstream

to fish farms in hydro-ecoregion

Normandie/Bretagne

Fish farming 122 500

Results of antimicrobial use monitoring Monitoring antibiotic use and AMR is essential:

• Recorded antibiotic sales since 1999 enable the calculation of the ALEA (animal level of exposure to antibiotics)

• It was made compulsory to declare any sales of antibiotics (law)

11

0

0,2

0,4

0,6

0,8

1

1,2

1,4

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

Tonnage

ALEA

nADD/biomasse

ECOANTIBIO

-37 % in 5 years (2012-2016)

CIA ALEA in 2016 : - 75% fluoroquinolones vs. 2013

- 81% C3/C4G vs. 2013

- 55% colistine vs. 2011

AMR monitoring

Downward trend of AMR since 2006

12

0

5

10

15

20

25

30

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

%

Tous bovins Porcs Poules/poulets Dindes Chiens Chevaux

E. coli resistance to fluoroquinolones in different animal species,

2017 (Résapath, ANSES).

Sales of veterinary antimicrobial agents in 30 European countries in 2015

13

Report from the European Medicines Agency, October 2017

Moyenne 135,5 mg/PCU

What should be improved?

• Communicating to all the stakeholders on the results of research

• Regulatory measures: more controls needed to ensure correct and full implementation

• Some actions take more time to be implemented

• Not really in a One Health spirit

• Need for breakpoints for sensitivity tests

• Need for complementary methods

Main upcoming difficulty: keep farmers and vets involved

14

4. Ecoantibio²: 2017-2021

15

Part of the interministerial roadmap for controlling AMR:

http://agriculture.gouv.fr/le-plan-ecoantibio-2-2017-2021

One Health

Ecoantibio²: main objectives

Evaluate Ecoantibio1:

• Cost/Benefit Analysis of implemented actions

• Comparative Analysis of Ecoantibio versus actions of other countries

Consolidate Ecoantibio1:

• Initiate and pursue actions in Ecoantibio1

Promote Ecoantibio1:

• Communicate achievements to public and stakeholders

Keep all stakeholders involved

Affirm and defend our positions internationally

A more targeted plan with more incentive measures and less regulatory measures

16

Focus of Ecoantibio² (20 actions) 1. Develop preventive measures for infectious diseases and ease the

procedure for using alternative treatments (4 actions)

2. Communicate and train on the issues of fighting AMR, on reasonable prescription of antibiotics and on methods to fight infectious diseases (4 actions)

3. Shared tools : Make evaluation and monitoring tools regarding AMU more widely available, as well as tools for the responsible prescription and administration (9 actions)

4. Shared efforts : Make sure the rules of correct use are applied at the national level and encourage their adoption at the EU and international levels (3 actions)

17

Focus on an Ecoantibio2 incentive measure communication campaign

for farmers and vets

« Antibiotics, as needed, when needed » 18

Take-home messages Thanks to veterinarians and farmers commitment

Include all stakeholders in dynamic virtuous cycle:

policy makers, vets, farmers, scientists and risk assessors, pharmacists, the pharmaceutical industry, public opinion including all animal owners

Co-construction of the plan, and co-implementation of the measures

Improving husbandry practices i.e. hygiene, farm building maintenance, animal health monitoring

Reinforcing partnership between prescribers and animal owners

Promoting prevention and alternatives such as vaccines

19

Thank you for your attention

To find more, please visit the Ecoantibio section:

http://agriculture.gouv.fr/ecoantibio

And the interministerial roadmap site https://solidarites-sante.gouv.fr/prevention-

en-sante/les-antibiotiques-des-medicaments-essentiels-a-preserver/

20

© Ministère de

l’Agriculture et

de l’Alimentation